Provider Demographics
NPI:1285480418
Name:COLEY, LEA KERLINDA
Entity type:Individual
Prefix:MRS
First Name:LEA
Middle Name:KERLINDA
Last Name:COLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6780 NW 44TH CT
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4031
Mailing Address - Country:US
Mailing Address - Phone:954-258-0612
Mailing Address - Fax:
Practice Address - Street 1:6780 NW 44TH CT
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4031
Practice Address - Country:US
Practice Address - Phone:954-258-0612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-29
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9282300163WA2000X
310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility